Inside the Outbreaks: The Elite Medical Detectives of the Epidemic Intelligence Service by Mark Pendergrast

Mark Pendergrast’s book, now available in paperback, has a little bit of everything.  History, politics, adventure in distant lands, men & women putting themselves in harm’s way for the good of mankind, epidemics, outbreaks and (I know this is gross) lots of diarrhea.  It’s hard to know where to begin. Officers in the Epidemic Intelligence Service specialize in tracking diseases and epidemics, on the ground, as they occur.  They excel in fieldwork – their logo features the worn sole of a shoe – and Pendergrast obviously sees them as the Indiana Jones-es of disease.  Inside the Outbreaks is a frenetically paced overview of the history of this agency and its greatest hits.

The Epidemic Intelligence Service was begun in 1951, the brainchild of Alexander Langmuir, and is now a part of the CDC (Center of Disease Control & Prevention).  Pendergrast keeps events in chronological order – dividing the book into 3 parts: 1951-1970, 1970-1982 & 1982-PRESENT.    In the beginning this made for unwieldy reading  (particularly on a Kindle).   The  EIS is an incredible multi-tasker.  At any given minute agents are in dozens of countries, researching a multitude of symptoms – with  mixed outcomes.   While this is a testament to the dedication of the agents, the constant jumping back and forth makes keeping track difficult.  In addition to the history of the diseases, you’ll read about the politics and the heartbreak of epidemiology:  who carried a grudge against who, what it was like to be the spouse of an agent, the slow rise of minorities in the EIS, who lives, who dies.   Pendergrast is fair, presenting the good with the morally repugnant (testing performed on the mentally handicapped, African-Americans, orphans and prisoners).  Trial and error is the underlying theme. Agents frequently build on their predecessors’ work.  Admittedly, it took me until the 1970′s to feel I had a grasp on what I was reading – but once there I was riveted and loathe to put the book down for even a second.

It was clear that the Biafran enclave would soon fall, and the U.S. Department of State wanted someone from the CDC to conduct a nutritional survey.  On October 14 Karl Western flew into Biafra with a State Department diplomatic team.  The Biafrans, focused on negotiating a peace settlement, did not want a nutritional survey done. “I anticipated this,” Western recalled.  “I had brought two jerry cans of petrol, a letter of introduction from Bill Foege, and somewhiskey for the missionaries.”  He slipped away from the negotiations and hitched a ride by holding up a jerry can.  Since gas was rare, the driver stopped.

Western conducted a random population survey in thirty-six widely distributed sites in eight provinces of Biafra.  Of the 2,676 villagers he examined, 31.4 percent were severely malnourished.  There were few very young or elderly villagers, since most had died.  “The most important question was how many people were in the enclave,” he recalled.  “Some said one million.  Some said ten million.” Western found that 67.2 percent of his sample had smallpox scars.  Knowing that over a million doses of smallpox vaccine had been administered in the area during the campaign, he extrapolated to estimate the total Biafran population was 3.23 milliion.  Of those, roughly a million suffered from advanced protein malnutrition.  Amazingly, Western accomplished all of this in less than two weeks.

All your big name diseases make an appearance: polio, measles, small pox, malaria, Reye’s & toxic shock syndrome, Hep B, influenza, Ebola… I’d go on but I hate to name drop.  Even if you have only a passing interest in science and medicine I recommend this book.  Inside the Outbreaks is inspirational and for my money a better real life adventure story than the more popular The Lost City of Z.  The original dust jacket featured a comic book style superhero – whereas the new cover is a much more somber view of a slide under a microscope.  The former is better.  There is definitely an episodic, graphic novel, quality to Pendergrast’s writing.  It also reminded me of the old black & white news reels  – complete with the booming voiced, up-beat narrator.  You probably think I’m mixing metaphors here, but what both graphic novels and black & white newsreels have in common is that each installment tells a self-contained story, the threads of which are picked up and expanded on in later installments and eventually become part of an even larger story arc.   It can be difficult at first to wrap your head around the fact that this is not a book about a specific disease but one dedicated to an agency that deals in diseases.  Instead of Batman, Inside the Outbreaks gives you the whole Justice League.

Note: you can find a simplified CDC timeline here of the history of the EIS.

Publisher: Mariner Books, New York (2011).
ISBN:  978 0 54 752030 8

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In the Wake of the Plague: The Black Death & the World It Made by Norman F. Cantor

The hypothesis on which Norman F. Cantor bases his book – In the Wake of the Plague: The Black Death & the World It Made – is sound. That the Black Plague swept across Europe and performed a kind of natural selection that set the course of history is indisputable. Cantor manages to also make it completely uninteresting. Almost immediately the book falls into a pattern of “because this person died of the Black Death, that person came into power”. And while this is all probably true, men and women in the Middle Ages did not exclusively die from the Plague (a point Cantor makes as well, undermining his own argument). The title and subject of his research could easily have been Cholera & the World It Made or Small Pox & the World It Made. All were equally deadly, comparatively devastating and arguably as influential to Western history. People can die of many, many things – what Cantor fails to do is convince the reader as to why his vehicle of death was so much more devastating than all the others.

Which is a shame, because there are some very interesting bits to this book. As a connoisseur of disease non-fiction (a.k.a. – a hypochondriac-in-training), I found the theories on the possible origins of the Black Death and the bio-medical data fascinating. What’s not to like about extraterrestrial viruses dropped to Earth in cosmic dust? Or the idea, really quite convincing, that the Black Death was actually concurrent outbreaks of multiple disease – such as Bubonic Plague and Anthrax? Or that a genetic relationship may exist between the Black Death and AIDS, which causes modern ancestors of those who survived the former to be immune to the latter disease? In my opinion, that’s wow-factor Cantor was looking for. Not the fact, however interesting in its own way, that Princess Joan of England died on the eve of her marriage to a Spanish prince and thus thwarted an alliance between the two countries that could have changed history. <yawn>

The other day there was a program on The History Channel about WWI trenches, many of which still remain part of the European landscape. I love WWI history and was instantly transfixed. But I quickly became frustrated as I realized that, based solely on the belief that more people were interested in WWII & Adolf Hitler than on WWI trenches, the host kept repeating (like clockwork, before every commercial break) that being a German soldier in the trenches during WWI made Hitler the man he became. It was a ridiculous and obvious ploy to use the name “Hitler” to drum up additional viewers. Ridiculous, because if it is true how  do you explain away the thousands of soldiers, on both sides of the Western front, who didn’t become Hitler?

It’s difficult not to feel that Cantor (like the producers at The History Channel) refused to follow the direction In the Wake of the Plague wanted to take in a misguided attempt to make it commercially viable and to target a more casual, “narrative nonfiction” reader. The result is a book that is schizophrenic – structurally choppy and which jumps from one topic to the next without linkage or logic. Worse yet is the tone of the writing, which I believe was meant to be conversational but instead comes across as cranky and grudging. Norman F. Cantor is obviously an intelligent individual – a Rhodes Scholar, a Fulbright Professor and a Porter Ogden Jacobus Fellow at Princeton University (I’ve no idea what that is, but it sounds impressive). So it seems a shame, and a decided loss to his readers, that he chose to serve us history lite this time around.

Publisher: Harper Perennial, New York (2002).
ISBN: 978 0 06 001434 6

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